Mood Disorders

Mood Disorders

• diagnosed on a spectrum from mild to severe symptoms

• mild symptoms may be treated on an outpatient basis while severe symptoms require hospitalization to prevent SH
  
  

Ranges

• Depression

  • mild depressive disorders called dysthymia

• Mania

  • mild called hypomania

• Bipolar

  • more severe symptoms of both

Depressive Disorders

• symptoms of

  • sadness

  • empty

  • lonely

  • irritable

  • thinking impairment

• impact’s ability to function

• incudes

  • disruptive mood dysregulation disorder

  • persistent depressive disorder

  • premenstrual dysphoric disorder

  • major depressive disorder

Disruptive Mood (MDMM)

• Dan

• is

• so

• rude ,irritable, and

• unstable

• proper

• treatment

• is going to be

• varied based on his symptoms and problem focused

• even at home, school, and with his peers

• affects male more

• usually school age children

Persistent Depressive Disorder

• affects females more

• feeling of depression that persist

• 2+ years

• usually does not cause hospitalization

Premenstrual dysphoric disorder

• management

  • regular exercise

  • dietary changes

  • enough sleep

• medication

  • SSRI

• Therapy

  • acupuncture

  • light therapy

  • relaxation

• Usually happens the week prior to a woman’s period

Seasonal affective disorder (SAD)

• light therapy

• CBT

• medications

• depletion of vitamin D in less sunny seasons

Major Depressive Disorder

most common disorders

higher rate

• female

• young adults 18-25

• people who identify as 2+ races or as being white

episodes result in significant change in normal everyday functioning

Causes

• genetics

• brain injury

• history of abuse

• history of parental neglect

• traumatic experience

• constant exposure to violent

• grief

• unemployment

• relationship problems

• financial issues

• physical issues

• substance abuse

s/s

• low mood

• excessive overthinking

• frustration

• hopelessness

• worthlessness

• irritability

• feelings of guilt

• loss of pleasure

• memory problems

• emotional outburst

• substance abuse

• suicidal tendencies

• fatigue

• body aches

• eating and sleeping disorders

Epidemiology

• leading cause of disability in US

• affects 1-20

  • children and adolescents

  • older adults

• comorbidity

  • frequently co-occur with other psychiatric disorders

  • occurrence greatly increases with those with chronic medical disorders

Screening tools

• common

  • deck depression inventory

  • Hamiliton depression scales

  • PHQ-9

• most dangerous aspect

  • suicidal

    • ideation=thought

    • plan=how/when/where

    • intent= intends to carry out plan

Nursing process

• areas to assess

  • affect

    • outward representation of internal state

  • thought process

  • mood

  • feelings

    • guilt

    • helplessness

    • hopelessness

    • worthless

    • anger

    • irritability

  • physical behaviors

    • grooming

    • hygiene

    • sexual interest

    • sleep patterns

  • communication patterns

  • religious beliefs and spirituality

• age considerations

  • children and adolescents

  • older adults

• self-assessment

  • frustration, hopelessness, annoyance common

  • recognize unrealistic expectations of yourself or your patient

• feeling what the patient is feeling

  • supervision and peer support can increase nurses therapeutic potential

• potential nursing diagnoses

  • risk for suicide- always the highest priority

  • hopelessness

  • ineffective coping

  • social isolation

  • spiritual distress

  • self-care deficit

• evaluation

  • SI- at admission, change in condition, and prior to discharge

  • intake

  • sleep pattern

  • personal hygiene and grooming

  • self-esteem

  • social interaction

psychopharmacological interventions

• antidepressants

  • SSRIs

    • first line

    • broad clinical implications

    • adverse effects

      • anxiety

      • agitation

      • anxiety

      • sleep disturbances

    • potential toxic effects

      • serotonin syndrome

        • abdominal pain

        • diarrhea

        • sweating

        • fever

        • tachycardia

        • most at risk with concurrent SSRI and MAOI use

      • ECT

        • most effective treatment

        • used for people who may be unable to take meds

Bipolar Disorder

• experience both depression and mania

• further classified by type 1 and type 2 or cyclothymic disorder

  • cyclothymic disorder is diagnosed when the clients alternate between mania and mild to moderation depression for at least 2 years

    • not as severe at type 1 or 2

• epidemiology

  • 21% of MDD may have undiagnosed bipolar disorder

  • bipolar 1

    • more common in males

    • median age of onset is 18

  • bipolar 2

    • more common in females

    • median age of onset is 20

  • cyclothymic disorders

    • usually begins in adolescence or early adulthood

    • 15-50% risk that they will develop bipolar 1 or 2

Mania

• distractibility

• impulsivity

• grandiosity

• gligth of ideas

• activity increase

• sleep deficit

• talkativeness

• surface may seem positive

• full mania

  • hallucination and delusions

  • high risk of violence towards self or others

• must cause significant impairment of issue with social occupational functioning or require hospitalization

Hypomania

• manic- not fully as seen in bipolar 1

• milder

• last for a shorter duration

• no psychotic symptoms

• able to continue daily activities without being too badly affected

Dysthymia

• depressed by milder and longer lasting

• most often seen in cyclothymia

• fewer symptoms of MDD

  • less severe symptoms

  • not a huge safety component

Depressive

• similar to major depression

• elevated risk of self-harm

  • may require hospitalization for stabilization

Risk Factory

• hypothyroidism

• weight gain

• cold intolerance

• cool,dry skin

• depression

• slower speech/mental affect

• fatigue, lethary

• delayed relation of tendon relfexes

• hair loss

• puffy face and eyelids

• bradycardia

• goiter

• edema

• carpal tunnel syndrome

• proximal myalgia

Assessment

• mood

• behavior

• thought process and speech patterns

• cognitive functioning

Pharmacological interventions

• lithium carbonate

  • indications

    • treatment of bipolar 1

  • narrow therapeutic range

  • maintence therapy

• can use anticonvulsant mood stabilizers

Lithium toxicity